Mother’s Day Grief Retreat

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1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Email* Phone*
Guest 1		First Name* Last Name* Email* Phone*

After completing this form, emails will be sent to everyone in your group to complete their information.

4 Participant Info

Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Choices about how you nourish yourself on a regular basis *	This is your daily, baseline dietary choice - not a dietary style you would like to explore. Please note that individual dietary "likes and dislikes" cannot be accommodated but we have a wide variety of delicious offerings at every meal.
These are food allergies and food intolerances that impact your health. *	If applicable, please provide as much detail as possible about your dietary restrictions, allergies and intolerances including but not limited to Gluten, Dairy, Egg, Nuts, Soy, Shellfish, Onion, Garlic, etc. Please share if you follow health driven diets like low sodium, FODmap, etc. Otherwise, simply type "none." Please note: we cannot guarantee that there will be no cross-contamination due to other meals cooked in the kitchen. Recipe ingredients available upon request. We are not a celiac-certified kitchen.
Do you need Ground Transportation to Limina?	Yes No If yes, one of our staff members will reach out to help coordinate your ground transportation.
Which airport or bus station will you be arriving into?
Please share you estimated arrival time - (Earliest arrival is 3pm, Tour is 5:30) *	Please try to be present for our tour at 5:30 pm so you can learn all about our amenities and offerings. We understand that plans can change, and a general sense of your travel plans is helpful to our staff. Dinner is served at 6:30 pm.
Additional comments about your stay	Please share anything else that you would like us to know prior to your stay. All responses are confidential.

5 Meals

6 Transportation

7 Support Limina Scholarships

8 Security Check

9 Payment

	By submitting payment, you authorise Limina Renewal Center to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Limina Renewal Center's agreement with you.